{"id":5200,"date":"2016-08-22T19:32:32","date_gmt":"2016-08-23T01:32:32","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=5200"},"modified":"2016-08-22T19:32:32","modified_gmt":"2016-08-23T01:32:32","slug":"why-oh-why-wont-single-payerpublic-option-go-away","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html","title":{"rendered":"Why, oh, why, won’t single-payer\/public option go away?"},"content":{"rendered":"\n<\/head>

\"https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg;<\/p>\n

So I have to say, I am not a big Costco\/Sam\u2019s Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family to shop for, back when you could have a fee-free membership and pay a modest upcharge instead. \u00a0\u2018Bout the only thing I remember buying were extra-giant-sized containers of chocolate chips, back in the day when I could eat all the chocolate I wanted and not gain weight. \u00a0But the logic was that these warehouse stores could sell their wares cheaply because their packaging costs were reduced with larger sizes. \u00a0Eventually I concluded that the prices weren\u2019t all that better than sale prices at my local supermarket.<\/p>\n

Today Slate had<\/a> \u2014 again \u2014 an article promoting the \u201cpublic option\u201d and \u2014 again \u2014 lauded its benefits as<\/p>\n

a government-offered health care plan that, with lower administrative costs, no profit expectations, and the bargaining power of the federal government, would compete aggressively alongside private plans.<\/p><\/blockquote>\n

Now, we\u2019re already seen co-ops failing, one after the other, proving that non-profit status and a mission of serving the public aren\u2019t enough to keep a provider in the black.<\/p>\n

So what about the other two selling points?<\/p>\n

I don\u2019t really see how a \u201cpublic option\u201d would have lower administrative costs. \u00a0True, that\u2019s the selling point of a single-payer system \u2014 although much of the administrative cost would remain, such as processing claims, paying doctors, reviewing treatments, and general record-keeping, such expenses as marketing costs would be (largely) eliminated. \u00a0But the \u201cpublic option\u201d would still have to market, even if it\u2019s labelled differently, such as \u201cpublic awareness campaigns.\u201d \u00a0And I\u2019ve often thought that a lot of the claims processing cost could be reduced by allowing insurers and providers to work together on a common claims system via some kind of anti-trust exemption.<\/p>\n

And \u201cbargaining power\u201d? \u00a0Sure, that makes sense if you are buying a product in bulk, where the provider can actually provide its services\/product for a lower cost because you\u2019re buying in volume, in a Sam\u2019s Club fashion. \u00a0But in the case of healthcare, we\u2019re talking about doctors in private practice, doctors affiliated with hospitals, and hospitals and hospital chains which, however much they are growing, are still not the equivalent of your employer or mine having a nationwide contract with a single vendor.<\/p>\n

So what we\u2019re really talking about is the government fixing prices.<\/p>\n

Now, as it happens, just this past Friday, Megan McArdle<\/a> had an article about this subject. \u00a0She wrote,<\/p>\n

Now, the public option could, with legal support, perhaps force providers to take those rates\u00a0[Medicare plus 5 or 10%]\u00a0\u2014 say \u201cIf you don\u2019t accept public option patients, you can\u2019t see Medicare patients either.\u201d The problem is that if you try that, all the groups who would be affected: hospitals, doctors, auxiliary service providers, health-care workers\u2019 unions and so forth \u2014 will descend upon their legislators with the white-hot fury of a thousand suns. These folks are well organized. They are extremely mediagenic. No lawmaker wants to be seen cutting the salaries of nurses in the neonatal intensive care unit.<\/p><\/blockquote>\n

That\u2019s been the answer to the single-payer supporters, too: \u201cthe only way to get single payer to work is to force cost cuts on medical providers, and if we can\u2019t even implement the \u2018Doc Fix\u2019 we have no hope of getting more comprehensive cuts.\u201d<\/p>\n

And as it also happens, I read a book that thought it had an answer to this issue. \u00a0It\u2019s called 5 Easy Theses<\/em>, by James M. Stone, and, while I didn\u2019t find enough useful in it to merit an entire \u201cfrom the library\u201d write-up, it has a couple interesting observations, e.g.,<\/p>\n

[a weakness in the case for single-payer is] when an opponent asks why Medicare and Medicaid don\u2019t already provide all the benefits attirbuted to a single-payer system. . . . When the private portion of the market sets the standards for frequency of testing, drug usage and cost, and compensation for every variety of medical services, it is extremely hard for any accompanying single-payer programs to be more parsimonious. \u00a0(p. 168 \u2013 169)<\/p><\/blockquote>\n

Is he right? \u00a0Would doctors lose all their leverage in a single-payer world? \u00a0It certainly is the case that doctors are paid less in those single-payer or single-payer-ish countries, as we saw paying doctors\u2019 bills in Germany. \u00a0But that\u2019s a lot of savings to be squeezed.<\/p>\n

Consider, after all, that, even disregarding the ObamaCare subsidies, that is, in 2010, before those subsidies were implemented, the public healthcare spending (Medicaid, Medicare, and other spending) alone exceeded, in PPP-adjusted dollars, that of nearly every OECD country (Norway, the Netherlands, and Luxembourg were higher), and, for the money, every other country provide (nearly) universal healthcare. \u00a0(See here for a chart<\/a>.)<\/p>\n

\u00a0<\/p>\n

So what\u2019s the answer? \u00a0Me, I never understood why staff-model HMOs (see the last part of this post<\/a>) didn\u2019t get us where we need to be.<\/p>\n

\u00a0<\/p>\n

image: \u00a0https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

So I have to say, I am not a big Costco\/Sam\u2019s Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family to shop for, back when you could have a fee-free membership and pay a modest upcharge instead. \u00a0\u2018Bout the only thing I remember buying were […]<\/p>\n","protected":false},"author":2209,"featured_media":5217,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[207,133,256],"class_list":["post-5200","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-health-care","tag-healthcare","tag-obamacare"],"yoast_head":"\nWhy, oh, why, won't single-payer\/public option go away?<\/title>\n<meta name=\"description\" content=\"So I have to say, I am not a big Costco\/Sam's Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why, oh, why, won't single-payer\/public option go away?\" \/>\n<meta property=\"og:description\" content=\"So I have to say, I am not a big Costco\/Sam's Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html\" \/>\n<meta property=\"og:site_name\" content=\"Jane the Actuary\" \/>\n<meta property=\"article:published_time\" content=\"2016-08-23T01:32:32+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/wp-media.patheos.com\/blogs\/sites\/533\/2016\/08\/800px-Doctor_examines_patient_1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"768\" \/>\n\t<meta property=\"og:image:height\" content=\"500\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Jane the Actuary\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jane the Actuary\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html\",\"url\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html\",\"name\":\"Why, oh, why, won't single-payer\/public option go away?\",\"isPartOf\":{\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website\"},\"datePublished\":\"2016-08-23T01:32:32+00:00\",\"dateModified\":\"2016-08-23T01:32:32+00:00\",\"author\":{\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a\"},\"description\":\"So I have to say, I am not a big Costco\/Sam's Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family\",\"breadcrumb\":{\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Why, oh, why, won’t single-payer\/public option go away?\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website\",\"url\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/\",\"name\":\"Jane the Actuary\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a\",\"name\":\"Jane the Actuary\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g\",\"caption\":\"Jane the Actuary\"},\"url\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/author\/actuaryjane\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Why, oh, why, won't single-payer\/public option go away?","description":"So I have to say, I am not a big Costco\/Sam's Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html","og_locale":"en_US","og_type":"article","og_title":"Why, oh, why, won't single-payer\/public option go away?","og_description":"So I have to say, I am not a big Costco\/Sam's Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family","og_url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html","og_site_name":"Jane the Actuary","article_published_time":"2016-08-23T01:32:32+00:00","og_image":[{"width":768,"height":500,"url":"https:\/\/wp-media.patheos.com\/blogs\/sites\/533\/2016\/08\/800px-Doctor_examines_patient_1.jpg","type":"image\/jpeg"}],"author":"Jane the Actuary","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Jane the Actuary","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html","url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html","name":"Why, oh, why, won't single-payer\/public option go away?","isPartOf":{"@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website"},"datePublished":"2016-08-23T01:32:32+00:00","dateModified":"2016-08-23T01:32:32+00:00","author":{"@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a"},"description":"So I have to say, I am not a big Costco\/Sam's Club shopper, but many of my neighbors are, and I remember\u00a0browsing their aisles long before I had a family","breadcrumb":{"@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/08\/why-oh-why-wont-single-payerpublic-option-go-away.html#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.patheos.com\/blogs\/janetheactuary"},{"@type":"ListItem","position":2,"name":"Why, oh, why, won’t single-payer\/public option go away?"}]},{"@type":"WebSite","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website","url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/","name":"Jane the Actuary","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a","name":"Jane the Actuary","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g","caption":"Jane the Actuary"},"url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/author\/actuaryjane"}]}},"_links":{"self":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/posts\/5200","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/users\/2209"}],"replies":[{"embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/comments?post=5200"}],"version-history":[{"count":0,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/posts\/5200\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/media\/5217"}],"wp:attachment":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/media?parent=5200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/categories?post=5200"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/tags?post=5200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}